Richard Fiorini: In health insurance, the fox is watching the henhouse

Friday

Feb 29, 2008 at 12:01 AMFeb 29, 2008 at 10:27 AM

I fully agree with one point in your editorial on controlling health care costs: “That’s what you get when you let the health insurance industry write the reforms.”

Richard Fiorini

I fully agree with one point in your editorial on controlling health care costs: “That’s what you get when you let the health insurance industry write the reforms.”

I would like to refer you to a recent New England Journal of Medicine article that came out Feb. 7. The article, “Market-Based Failure – A Second Opinion on U.S. Health Care Costs,” refutes the notion that the market can optimize the efficiencies of medicine.

In one of the early paragraphs he points out the inefficiency of our multiple-payer bureaucracies which “siphon off $400 billion to $500 billion of the $2.2 trillion spent” for total health care expenditures.

I have not read recently about any layoffs at the large health insurance companies due to poor profits. Insurance companies are not forced to increase their efficiency. When their profits are threatened, they can raise premiums, increase the cost of deductibles and co-payments, decrease pay-outs to doctors and hospitals and limit their services to patients.

No one is asking them to reduce the salaries of their executives, or pare down their advertising budget, streamline their billing processes, or use their clout to get pharmaceutical companies to lower the cost of medications.

How else do you explain the $16.4 million severance package that the retiring CEO of Blue Cross Blue Shield William C. Faasen is receiving? Because he made the business profitable.

I agree that businesses pay a lot to insure their employees. It is only natural for an employer to look at the bottom line cost for his company’s insurance. What the boss does not realize is the insurance companies are not reducing the cost of the insurance by increasing their own efficiency, but reducing what they pay to doctors and hospitals.

The smartest graduates will be going into business professions to make a good living, not to medical school. And when medical graduates come out of school with large loans, the lure of a high-paying specialty is more attractive than primary care. Then everyone wants to know why there is a shortage of primary care health professionals in this state.

I do not believe insurance companies have patients’ best interests in mind. The fox is never good at guarding the henhouse. They are a business, and their first concern is their bottom line.

Thus, health care for all will not be affordable if we pursue health insurance for all without recognizing it for the inefficient business bureaucracy it is.

Richard Fiorini, a doctor for more than 27 years, practices emergency medicine and internal medicine at Morton Hospital in Taunton. He lives in Duxbury.

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